An Atypical Case of Miyazaki Syndrome with Internal Jugular Vein Stenoses and Persistent Cervical Subdural Effusions

We detail a case of overshunting associated myelopathy, or Miyazaki syndrome, in a patient with an implanted ventriculoperitoneal shunt. This case is unique because the cord compression was mainly due to a subdural effusion, which did not resolve after correction of CSF over-shunting. We aim to show that the presence of bilateral internal jugular vein stenoses may have led to preferential development of cervical epidural venous drainage and congestion, which subsequently led to subdural effusion.

Learning Objectives:

Recognize factors that contribute to the development of Miyazaki Syndrome.

Differentiate Miyazaki Syndrome from simple intracranial hypotension.

Identify causes of preferential outflow into the cervical epidural venous plexus.